Geographical and Temporal Variation in the Incidence and Mortality of Hepato-Pancreato-Biliary Primary Malignancies:1990-2017.

BACKGROUND: Hepatic, pancreas, and biliary (HPB) cancers pose serious challenges to global health care systems. These malignancies demonstrate great geographical variations with shifting trends over time. The aim of the present study was to determine the recent trends in incidence, prevalence, and mortality of primary HPB malignancies to guide the further development of effective strategies for prevention, screening, and treatment. METHODS: The Global Burden of Disease (GBD) dataset 1990-2017 was interrogated for end point variables by age, sex, year, and geography. Epidemiologic data were modeled in DisMod-MR 2.1, a Bayesian meta-regression tool that pools data points from different sources and adjusts for known sources of variability. Global Burden of Disease data were extracted from 284 country-year, and 976 subnational-year combinations from 27 countries in North America, Latin America, Europe, India, and New Zealand. RESULTS: Although the global incidence of primary HPB malignancies increased by 1.43% from 1990 to 2017 (1,400,739 cases), the incidence of extrahepatic biliary and gallbladder malignancies decreased by -0.32% (210,878 cases) over the same period. There was significant variability in the incidence, prevalence, and mortality of HPB cancers by the sociodemographic index (SDI), as well as by geography. The largest incidence increase of primary liver and pancreas cancers was seen in the high-income Asia-Pacific group, followed by the high-income North America and Western Europe groups. The highest incidences and prevalence of extrahepatic biliary and gallbladder malignancies were observed in Asia-Pacific, Southern Latin American, and Andean Latin American regions. In general, mortality rates of HPB malignancies were larger in the low SDI when compared with the high SDI group in all geographical regions. CONCLUSIONS: The global incidence and prevalence of primary liver and pancreatic malignancies continue to increase with great geographical variation. The mortality trends mirror those of the incidence. Although the global incidence and prevalence of extrahepatic biliary and gallbladder malignancies has decreased, the mortality rate has not significantly changed. The results of this article can assist local and regional authorities in policy development to improve health care access for screening, early detection, and treatment of HPB malignancies.

Mirrored morality: an exploration of moral choice in video games.

This exploratory study was designed to examine how players make moral choices in video games and what effects these choices have on emotional responses to the games. Participants (n=75) filled out a moral foundations questionnaire (MFQ) and then played through the first full act of the video game Fallout 3. Game play was recorded and content analyzed for the moral decisions made. Players also reported their enjoyment of and emotional reactions to the game and reflected on the decisions they made. The majority of players made moral decisions and behaved toward the nonplayer game characters they encountered as if these were actual interpersonal interactions. Individual differences in decision making were predicted by the MFQ. Behaving in antisocial ways did increase guilt, but had no impact on enjoyment.

The relationship between selective exposure and the enjoyment of television violence.

The existing research on the appeal of media violence has led to an apparent incongruity: violent content tends to increase selective exposure to media, but violence often decreases enjoyment. In this experiment, we used two independent manipulations to assess the role of violence in both selective exposure and enjoyment in order to examine the relationship between the two. Program descriptions for four prime-time television dramas were altered to create violent and nonviolent descriptions for each episode. Then the episodes themselves were edited to create violent and nonviolent versions of each. Participants (N = 191) were more likely to choose violent descriptions to watch, but enjoyed the nonviolent episodes more than the violent episodes. Moreover, the nonviolent episodes were rated as more enjoyable even when the participants had chosen to watch a violent program description. From a theoretical perspective, these results suggest the need to move beyond explaining the appeal of violence in terms of increased enjoyment and instead further explore other motivations that could be driving selective exposure to violent content.

Setting cumulative emissions targets to reduce the risk of dangerous climate change.

Avoiding "dangerous anthropogenic interference with the climate system" requires stabilization of atmospheric greenhouse gas concentrations and substantial reductions in anthropogenic emissions. Here, we present an inverse approach to coupled climate-carbon cycle modeling, which allows us to estimate the probability that any given level of carbon dioxide (CO2) emissions will exceed specified long-term global mean temperature targets for "dangerous anthropogenic interference," taking into consideration uncertainties in climate sensitivity and the carbon cycle response to climate change. We show that to stabilize global mean temperature increase at 2 degrees C above preindustrial levels with a probability of at least 0.66, cumulative CO2 emissions from 2000 to 2500 must not exceed a median estimate of 590 petagrams of carbon (PgC) (range, 200 to 950 PgC). If the 2 degrees C temperature stabilization target is to be met with a probability of at least 0.9, median total allowable CO2 emissions are 170 PgC (range, -220 to 700 PgC). Furthermore, these estimates of cumulative CO2 emissions, compatible with a specified temperature stabilization target, are independent of the path taken to stabilization. Our analysis therefore supports an international policy framework aimed at avoiding dangerous anthropogenic interference formulated on the basis of total allowable greenhouse gas emissions.

Out of Africa and into an ice age: on the role of global climate change in the late Pleistocene migration of early modern humans out of Africa.

The results from two climate model simulations are used to explore the relationship between North Atlantic sea surface temperatures and the development of African aridity around 100,000 years ago. Through the use of illustrative simulations with an Earth System Climate Model, it is shown that freshwater fluxes associated with ice sheet surges into the North Atlantic, known as Heinrich events, lead to the southward shift of the intertropical convergence zone over Africa. This, combined with the overall increased aridity in the cooler mean climate, leads to substantial changes in simulated African vegetation cover, particularly in the Sahel. We suggest that Heinrich events, which occurred episodically throughout the last glacial cycle, led to abrupt changes in climate that may have rendered large parts of North, East, and West Africa unsuitable for hominin occupation, thus compelling early Homo sapiens to migrate out of Africa.

Nurses and healthcare chaplains: natural allies.

The collaborative relationship between nurses and chaplains in the health care setting is well documented. The authors review research findings including survey results demonstrating the importance of religion and spirituality in the general population and the importance of the religion and faith in people suffering illnesses. Nurses and physicians show marked differences in their attention to spiritual care as evidenced by nurses' higher rates of referrals to chaplains and the greater quantity of nursing research on sprirituality in professional journals. Three factors that might account for nurses' recognition of spiritual needs are: 1) the inclusion of spiritual care in the nursing curriculum, 2) personal involvement in faith communities and, 3) the historical influences of the nursing profession. Further research of this partnership and its effect on patient care should ultimately benefit the most vulnerable individuals in the health care setting.

A review of research on Buddhism and health: 1980-2003.

Electronic searches of social science and biomedical literature identified 44 empirical studies that specifically investigate Buddhism, meditation, and health. The number of studies increased over time, especially in medical and other health-related fields. The studies were found to differ by geographical region with regard to the emphasis on spiritual, psychological, or physical outcomes. Results from this study are explored with respect to historical trends as well as current variations in scholarship and religious practice between the regions.

Chaplaincy research: its value, its quality, and its future.

The article is divided into four major sections, the first of which presents and discusses various reasons given by major researchers in the field why chaplains should do research. The second section summarizes findings on the sophistication of research on religion and health published in (a) medical and other healthcare journals, and (b) specialty journals on religion and health, chaplaincy, and pastoral care and counseling. The third section revisits suggestions that have been made by prominent chaplain researchers to increase and improve research by chaplains. The last section offers some suggestions for expanding several lines of current research in the future, including research: (1) to elucidate the nature of spiritual care chaplains provide to different populations, including patients, families and staff; (2) to assess the prevalence and intensity of patients' spiritual needs and the degree to which they are being met; (3) to identify that subset of patients who are spiritually at risk in terms of having high needs and slow religious resources; (4) to identify the biological causal mechanisms by which religion influences health; and (5) to measure the effectiveness of chaplain interventions.

Stochastic models of the meridional overturning circulation: time scales and patterns of variability.

The global meridional overturning circulation (MOC) varies over a wide range of space and time scales in response to fluctuating 'weather' perturbations that may be modelled as stochastic forcing. This study reviews model studies of the effects of climate noise on decadal to centennial MOC variability, on transitions between the MOC regimes and on the dynamics of Dansgaard-Oeschger events characteristic of glacial periods.

Comment on "Saturation of the southern ocean CO2 sink due to recent climate change".

We disagree with the conclusion of Le Quéré et al. (Reports, 22 June 2007, p. 1735) that poleward intensifying winds could continue to weaken the Southern Ocean sink in the future. We argue that altered winds, along with rising atmospheric carbon dioxide, will likely increase the efficiency of this sink in the 21st century.

A national survey of hospital directors' views about the importance of various chaplain roles: differences among disciplines and types of hospitals.

A national random sample of hospital directors was asked to rate the importance of seven categories of chaplain roles and functions: 246 nursing directors, 267 social services directors, 307 medical directors, and 611 pastoral care directors. All four groups rated end-of-life care, prayer, and emotional support as being between very important and extremely important. Other roles, including consultation, advocacy, community outreach, and religious services and rituals were rated significantly less important. Significant differences were found across disciplines and hospital settings (general, psychiatric, etc.). Medical directors rated most chaplain roles lower than other directors did, and directors in psychiatric hospitals rated all roles, except religious services/rituals, lower than their counterparts in other types of hospitals. The importance that directors accorded to all the chaplain roles examined was also influenced by their own spirituality and religiosity, as well as the religious affiliation of their institution.

Compassion fatigue and burnout among Rabbis working as chaplains.

Compassion Fatigue, Compassion Satisfaction, and Burnout were studied in a convenience sample of 66 male and female Rabbis who work as chaplains and attended the annual conference of the National Association of Jewish Chaplains (NAJC) in 2002. Although Compassion Fatigue and Burnout were low among the survey participants, both measures were significantly higher among the women in the sample. Compassion Fatigue was also higher among chaplains who were divorced, and it increased with the number of hours per week the chaplains spent working with trauma victims or their families (r = .25, p<.05). Hierarchical multiple regression was performed to determine the influence of six professional and five personal variables on each of the three dependent variables. Four professional variables accounted for 19.5% of the variation and three personal variables accounted for 20.3% of the variation in Compassion Fatigue. Attempts to predict Burnout and Compassion Satisfaction were far less successful. Burnout was predicted by only two variables (i.e. age and years as a Rabbi), which accounted for just 18.4% of the variance in Burnout scores. Age was the only variable found to have a significant effect on Compassion Satisfaction, and its effect was positive. The implications of the findings are discussed.

A review of spiritual and religious measures in nursing research journals: 1995-1999.

BACKGROUND: A series of systematic reviews has revealed relatively high levels of interest in religion and spirituality in different nursing specialties, but not in general nursing research journals. PURPOSE: To identify the extent to which spirituality and religiousness were measured in all quantitative and qualitative research articles published in Research in Nursing and Health, Nursing Research, Advances in Nursing Science (ANS), and Image: The Journal of Nursing Scholarship from 1995 to 1999. METHODS: A full-text search was conducted of ANS and Image using the Ovid search system. Nursing Research and Research in Nursing and Health were hand searched for spiritual/religious measures. Characteristics of selected studies, the measures taken, and their uses were coded for data analysis. RESULTS: A total of 564 research studies were identified, of which 67 (11.9%) included at least one measure of spirituality or religiousness. A significant difference was found between the percentage of qualitative and quantitative studies that contained measures of these concepts. Of the 119 qualitative studies, 23 (19.3%) contained a measure of religion or spirituality, compared to 44 of the 445 (9.9%) quantitative studies. Nominal indicators of religious affiliation were the most commonly used measures in the quantitative studies and measures of religion and spirituality were rarely used in the analyses. Although only a few quantitative or qualitative studies intended to focus on religion or spirituality, these themes often emerged spontaneously in the qualitative research. CONCLUSIONS: Research in Nursing and Health, Advances in Nursing Science, Nursing Research, and Image: The Journal of Nursing Scholarship all published research measuring spirituality and religiousness during the time-period studies. The rate at which spirituality and religion appeared in these nursing research articles is substantially higher than that found in most fields outside of nursing. Even more frequent inclusion of spiritual and religious variables and richer measures of spirituality and religiousness would help to increase the available scientific information on the role of spirituality and religion in nursing care.

Correlates of compassion fatigue and burnout in chaplains and other clergy who responded to the September 11th attacks in New York City.

Participants at a June 2002 conference about the September 11th attacks were tested for compassion fatigue, compassion satisfaction, and burnout. The sample consisted of 343 clergy, including 97 chaplains. A total of 149 (43.4%) of the participants had responded as disaster-relief workers following the September 11th attacks. The number of hours clergy worked with trauma victims each week was directly related to compassion fatigue among responders and non-responders. Compassion fatigue also was positively related to the number of days that responders worked at Ground Zero, while disaster-relief work with the American Red Cross reduced compassion fatigue and burnout. Clinical Pastoral Education tended to decrease compassion fatigue and burnout and increase compassion satisfaction in both responders and non-responders. Burnout was inversely related to age in both groups.

A study of religion, ministry, and meaning in caregiving among health professionals in an institutional setting in New York City.

The clinical staff of a large metropolitan nursing home was surveyed about their religious practices, the degree to which they saw their work as a ministry, and the meaning they obtain from being caregivers. Age, race, gender, education, and various other measures were also taken. As hypothesized, religiosity made a significant positive contribution to participants' belief their work was a ministry to those in need. Multiple regression revealed that African American and older staff scored significantly higher on both dependent variables, whereas Caucasians were significantly less likely to view their work as ministry. Staff who worked with long-term patients derived significantly more meaning from their work, but they were no more likely to see it as ministry. Religiosity appears to enhance the meaning caregivers get from their work, and this may be beneficial to patients. Further research may identify other factors that enhance the meaning caregivers get from their work.